18F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment
18F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment
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DOI：
10.2967/jnumed.116.186403
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发表时间：
2017-12-01
影响因子：
9.3
通讯作者：
Hellwig, Sabine
中科院分区：
文献类型：
--
作者：
Meyer, Philipp T.;Frings, Lars;Hellwig, Sabine
帕金森病的准确鉴别诊断对于治疗和预后至关重要。此外，随着侵入性疗法和新型疾病特异性疗法的发展，试验人群中患者丰富的策略变得越来越重要。使用 PET 和 F-18-FDG 对区域葡萄糖代谢的疾病特异性模式进行成像，可以高度准确地区分帕金森病 (PD) 和非典型帕金森综合征，包括多系统萎缩、进行性核上性麻痹和皮质基底节变性。根据对当前包含多个疾病组的现有研究的初步荟萃分析，我们估计基于体素的统计分析支持的视觉 PET 读数诊断非典型帕金森综合征的诊断敏感性和特异性分别为 91.4% 和 90.6%。 F-18-FDG PET 诊断多系统萎缩、进行性核上性麻痹和皮质基底节变性的诊断特异性始终较高 (> 90%)，而敏感性则变化较大 (> 75%)。人们越来越认识到认知障碍是帕金森病的一个主要挑战，轻度认知障碍是帕金森病合并痴呆（PDD）的前驱阶段。与临床和神经心理学研究一致，最近的 PET 研究表明，非痴呆 PD 患者的后皮质功能障碍先于认知能力下降和 PDD 发生数年。总而言之，当前文献强调了 F-18-FDG PET 在帕金森病诊断评估中的实用性，以及 F-18-FDG PET 在 PD 认知障碍评估和风险分层中的前景广阔的作用。
Accurate differential diagnosis of parkinsonism is of paramount therapeutic and prognostic importance. In addition, with the development of invasive therapies and novel disease-specific therapies, strategies for patient enrichment in trial populations are of growing importance. Imaging disease-specific patterns of regional glucose metabolism with PET and F-18-FDG allows for a highly accurate distinction between Parkinson disease (PD) and atypical parkinsonian syndromes, including multiple-system atrophy, progressive supranuclear palsy, and corticobasal degeneration. On the basis of a preliminary metaanalysis of currently available studies with inclusion of multiple disease groups, we estimated that the diagnostic sensitivity and specificity for visual PET readings supported by voxel-based statistical analyses for diagnosis of atypical parkinsonian syndromes are 91.4% and 90.6%, respectively. The diagnostic specificity of F-18-FDG PET for diagnosing multiple-system atrophy, progressive supranuclear palsy, and corticobasal degeneration was consistently shown to be high (> 90%), whereas sensitivity was more variable (> 75%). It is increasingly acknowledged that cognitive impairment represents a major challenge in PD, with mild cognitive impairment being a prodromal stage of PD with dementia (PDD). In line with clinical and neuropsychologic studies, recent PET studies demonstrated that posterior cortical dysfunction in nondemented PD patients precedes cognitive decline and the development of PDD by several years. Taken together, the current literature underscores the utility of F-18-FDG PET for diagnostic evaluation of parkinsonism and the promising role of F-18-FDG PET for assessment and risk stratification of cognitive impairment in PD.